Mini-subvastus approach for total knee arthroplasty in obese patients

BACKGROUND: Mini-subvastus approach for Total Knee Arthropalsty allows a faster recovery. It is traditionally not utilized for obese patients because of difficulty in exposure of the knee and eversion of the patella. We hypothesized that obesity should not really cause a problem for patients undergoing a TKA with the mini-subvastus approach as the anatomy of the quadriceps in the obese and the nonobese patient population is the same. We present an analysis of the use of mini-subvastus approach in obese patients. MATERIALS AND METHODS: 97 obese patients (109 knees) 81 females + 16 males with mean age 64 years underwent total knee arthroplasty (TKA) by mini-subvastus approach between January 2006 to July 2007. 16 patients (18 kness) were morbidly obese. All patients were prospectively evaluated by pre- and postoperative Knee Society and function score. The average follow-up was 18 months (range from 1 to 3 years) with minimum 1 year follow-up. RESULTS: The approach provided adequate exposure in all knees, with an average surgical time of 90 minutes. The patella could be everted easily after the tibial and femoral cuts. The average Knee Society score improved from 42 to 89 and the function score from 48 to 65. The complications included medial collateral ligament injury (one case) and patellar tendon avulsion (one case). CONCLUSION: Our results compare favorably with other reported series in obese patients. The mini-subvastus approach can be considered in obese patients.